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The quality of screening colonoscopy in rural and underserved areas

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Abstract

Background

Screening colonoscopy effectiveness depends on procedure quality; however, knowledge about colonoscopy quality in rural and underserved areas is limited. This study aimed to describe the characteristics and quality of colonoscopy and to examine predictors of colonoscopy quality at rural and underserved hospitals.

Methods

Adults undergoing colonoscopy from April 2017 to March 2019 at rural or underserved hospitals across the Illinois Surgical Quality Improvement Collaborative were prospectively identified. The primary outcome was colorectal adenoma detection, and secondary outcomes included bowel preparation adequacy, cecum photodocumentation, and withdrawal time. Performance was benchmarked against multisociety guidelines, and multivariable logistic regression was used to examine patient, physician, and procedure characteristics associated with adenoma detection.

Results

In total, 4217 colonoscopy procedures were performed at 8 hospitals, including 1865 screening examinations performed by 19 surgeons, 9 gastroenterologists, and 2 family practitioners. Physician screening volume ranged from 2 to 218 procedures (median 50; IQR 23–74). Adenoma detection occurred in 26.6% of screening procedures (target: ≥ 25%), 90.7% had adequate bowel preparation (target: ≥ 85%), 93.1% had cecum photodocumentation (target: ≥ 95%), and mean withdrawal time was 8.1 min (target: ≥ 6). Physician specialty was associated with adenoma detection (gastroenterologists: 36.9% vs. surgeons: 22.5%; OR 2.30, 95% CI 1.40–3.77), but adequate bowel preparation (OR 1.15, 95% CI 0.76–1.73) and cecum photodocumentation (OR 1.56, 95% CI 0.91–2.69) were not.

Conclusion

Colonoscopies performed at rural and underserved hospitals meet many quality metrics; however, quality varied widely. As physicians are scarce in rural and underserved areas, individualized interventions to improve colonoscopy quality are needed.

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Acknowledgements

The authors would like to acknowledge all participating hospitals, surgeon champions, quality improvement designees, and surgical clinical reviewers in the ISQIC Rural Colonoscopy Quality Improvement Project.

Funding

The Illinois Surgical Quality Improvement Collaborative is supported by a grant from the Health Care Services Corporation/Blue Cross Blue Shield of Illinois. BCB was supported by the American College of Surgeons as part of the Clinical Scholars in Residence Program and by the National Cancer Institute [Grant No. T32CA247801]. ADY is supported by the National Institutes of Health [Grant No. K08HL145139]. RNK is supported by the Digestive Health Foundation and the Moore Foundation. KYB is supported by the Agency for Healthcare Research and Quality [Grant No. 5R01HS024516]. The funding organizations had no role in the design of the study, the collection, analysis, or interpretation of data, the writing of the report, or the decision to submit the article for publication.

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Author notes

  1. Lindsey Kreutzer

    Present address: Northwestern Medicine International Health, Chicago, IL, USA

Authors and Affiliations

  1. Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, 633 N. Saint Clair St., 20th Floor, Chicago, IL, 60611, USA

    Brian C. Brajcich, Anthony D. Yang, Karl Y. Bilimoria & Amy L. Halverson

  2. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA

    Brian C. Brajcich & Karl Y. Bilimoria

  3. Department of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Rajesh N. Keswani & Lindsey Kreutzer

  4. Department of Surgery, Fairfield Memorial Hospital, Fairfield, IL, USA

    Patrick L. Molt

  5. Department of Surgery, Hopedale Medical Complex, Hopedale, IL, USA

    Matthew B. Rossi

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Corresponding author

Correspondence to Amy L. Halverson.

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Disclosures

Rajesh N. Keswani reports providing consulting services for Boston Scientific Corporation and Neptune Medical Inc. Brian C. Brajcich, Anthony D. Yang, Lindsey Kreutzer, Patrick L. Molt, Matthew B. Rossi, Karl Y. Bilimoria, and Amy L. Halverson report no conflicts of interest or financial ties to disclose.

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Brajcich, B.C., Yang, A.D., Keswani, R.N. et al. The quality of screening colonoscopy in rural and underserved areas. Surg Endosc 36, 4845–4853 (2022). https://doi.org/10.1007/s00464-021-08833-z

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